PMID- 27786246
OWN - NLM
STAT- MEDLINE
DCOM- 20180813
LR  - 20181113
IS  - 1759-4766 (Electronic)
IS  - 1759-4758 (Linking)
VI  - 12
IP  - 11
DP  - 2016 Oct 27
TI  - HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and 
      treatment.
PG  - 662-674
LID - 10.1038/nrneurol.2016.149 [doi]
AB  - Nearly 30 years after the advent of antiretroviral therapy (ART), CNS 
      opportunistic infections remain a major cause of morbidity and mortality in 
      HIV-positive individuals. Unknown HIV-positive disease status, antiretroviral 
      drug resistance, poor drug compliance, and recreational drug abuse are factors 
      that continue to influence the morbidity and mortality of infections. The 
      clinical and radiographic pattern of CNS opportunistic infections is unique in 
      the setting of HIV infection: opportunistic infections in HIV-positive patients 
      often have characteristic clinical and radiological presentations that can differ 
      from the presentation of opportunistic infections in immunocompetent patients and 
      are often sufficient to establish the diagnosis. ART in the setting of these 
      opportunistic infections can lead to a paradoxical worsening caused by an immune 
      reconstitution inflammatory syndrome (IRIS). In this Review, we discuss several 
      of the most common CNS opportunistic infections: cerebral toxoplasmosis, 
      progressive multifocal leukoencephalopathy (PML), tuberculous meningitis, 
      cryptococcal meningitis and cytomegalovirus infection, with an emphasis on 
      clinical pearls, pathological findings, MRI findings and treatment. Moreover, we 
      discuss the risk factors, pathophysiology and management of IRIS. We also 
      summarize the challenges that remain in management of CNS opportunistic 
      infections, which includes the lack of phase II and III clinical trials, absence 
      of antimicrobials for infections such as PML, and controversy regarding the use 
      of corticosteroids for treatment of IRIS.
FAU - Bowen, Lauren N
AU  - Bowen LN
AD  - Section of Infections of the Nervous System, National Institute for Neurologic 
      Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 
      10/7C103, Bethesda, Maryland 28092, USA.
FAU - Smith, Bryan
AU  - Smith B
AD  - Section of Infections of the Nervous System, National Institute for Neurologic 
      Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 
      10/7C103, Bethesda, Maryland 28092, USA.
FAU - Reich, Daniel
AU  - Reich D
AD  - Translational Neuroradiology Unit, National Institute for Neurologic Disorders 
      and Stroke, National Institutes of Health, 10 Center Drive, Building 10/5C103, 
      Bethesda, Maryland 20892, USA.
FAU - Quezado, Martha
AU  - Quezado M
AD  - Department of Pathology, National Cancer Institute, National Institutes of 
      Health, 10 Center Drive, Building 10 Magnuson CC 2A10, Bethesda, Maryland 20892, 
      USA.
FAU - Nath, Avindra
AU  - Nath A
AD  - Section of Infections of the Nervous System, National Institute for Neurologic 
      Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 
      10/7C103, Bethesda, Maryland 28092, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Nat Rev Neurol
JT  - Nature reviews. Neurology
JID - 101500072
SB  - IM
MH  - *AIDS-Related Opportunistic Infections/diagnosis/etiology
MH  - *Cytomegalovirus Infections/diagnosis/etiology
MH  - *HIV Infections/complications/drug therapy
MH  - Humans
MH  - *Immune Reconstitution Inflammatory Syndrome/diagnosis/etiology
MH  - *Leukoencephalopathy, Progressive Multifocal/diagnosis/etiology
MH  - *Meningitis, Cryptococcal/diagnosis/etiology
MH  - *Toxoplasmosis, Cerebral/diagnosis/etiology
MH  - *Tuberculosis, Meningeal/diagnosis/etiology
EDAT- 2016/10/28 06:00
MHDA- 2018/08/14 06:00
CRDT- 2016/10/28 06:00
PHST- 2016/10/28 06:00 [pubmed]
PHST- 2018/08/14 06:00 [medline]
PHST- 2016/10/28 06:00 [entrez]
AID - nrneurol.2016.149 [pii]
AID - 10.1038/nrneurol.2016.149 [doi]
PST - ppublish
SO  - Nat Rev Neurol. 2016 Oct 27;12(11):662-674. doi: 10.1038/nrneurol.2016.149.